Health Association in New York State, Inc.
Friday Fax from Albany
OMH Budget Lacks COLA, Reinvestment: In a huge retrenchment from last years proposed Workforce Reinvestment Act, which would have extended the Community Mental Health Reinvestment Act, closed a total of five state operated childrens and adults psychiatric hospitals and provided a 3-year COLA and increase in the Medicaid reimbursement rate, all of those items are absent from this years budget.
At a budget briefing earlier this week, OMH Commissioner Jim Stone said that he was disappointed that those items could not be included in the proposed budget, and urged us to keep pursuing them with the legislature.
MHANYS has already begun pressing for an extension of Reinvestment, with President/CEO Joseph A. Glazer telling reporters, "The Community Mental Health Reinvestment Act expired in September 2001. There is no proposed extender in this Executive Budget, and community mental health programs are slated to take a $24 million hit in our time of greatest need. We will work with the governor and the legislature to restore Reinvestment now, and strive to develop a long term plan for the future".
HIGHLIGHTS OF EXECUTIVE BUDGET PROPOSAL FOR OFFICE OF MENTAL HEALTH 2002/03
Adult Program Bed Reduction: Eliminates 395 adult beds across the state. 4240 adult beds will be funded on March 31, 2003.
Annualization and Salary Adjustments: Funding is included for all contractually mandated increases for State employees.
Childrens Services: Residential Treatment Facilities are recommended to receive a trend factor for both the operating and educational components of the program.
Enhanced Community Service: Increase of $26 million for case management and Supportive Housing for adults
Housing Programs: Funding for an additional 800 beds during 2002-03 and additional 1,900 beds in subsequent years for adults with psychiatric disabilities and children with severe emotional disturbance. (The budget includes no money for new beds all beds were already in the pipeline)
Kendras Law: $32 million is provided for Assisted Outpatient Treatment (AOT) and the Medication Grants program.
Local Capital: New funding of $13 million and reappropriations of $162 million for preservation/enhancement of existing community mental health facilities and development of new community beds.
Project Liberty: Application pending for approximately $132 million in Federal grants for an additional nine months of disaster relief services in light of the terrorist attacks.
State Capital: New Capital appropriations for State facilities total $149.4 million, a $35 million increase over fiscal 2001-02.
Restoration of FY 2001-02 Reductions: Restores funding for ongoing NPS requirements, as well as to maintain staffing levels at Forensic Psychiatric Centers.
Vacant Shared Staff Positions: Elimination of 30 such positions by April 1, 2002. This is in addition to the 30-position reduction enacted in the 2001-02 budget.
Vacant Administrative and Finance Positions: Elimination of 20 such positions by April 1, 2002.
Workforce: Funding is provided for 17,581 positions through March 31, 2003. This reflects a reduction of 411 positions from the projected March 31, 2002 level.
Tickets are going fast, but you can still join Honorary Chairs Governor and Mrs. Pataki as well as many legislators and community leaders in supporting the Foundation. Tickets and information can be obtained from Judy Burgess, at 518-434-0439, ext. 31.
ESTLANSING, Mich. -- Tom Gadowski takes seven medications to treat his manic depression, spending $1,100 a month for an assortment of pills meant to fend off panic attacks, violent outbursts and suicidal thoughts. "I've been on everything, and what I'm on right now seems to have me most stable," he said. That stability may soon be shaken. Gadowski, who is unemployed and has about half his drug costs paid for by Medicaid, could find his medical regimen changed under a new Michigan law aimed at cutting the amount the state spends on drug costs. Under the sweeping new plan, to take effect Feb. 1, the state will allow doctors to prescribe only certain discounted medications to the 1.6 million low-income patients who rely on state aid, including Medicaid and programs for infants and the elderly. Doctors would have to get authorization for medications not on the list. Drug companies that refused to provide discounts risked removal of their drugs from the list. As a result, such well-known drugs as Prozac, Ritalin, the arthritis drug Celebrex and the antibiotic Cipro didn't make the list. Other states have taken similar steps. In Florida, a similar program limited to Medicaid patients was upheld by a federal judge earlier this month. Maine prohibits doctors from prescribing expensive drugs to low-income patients without permission, while Indiana limits low-income patients to four brand-name drugs per month. The Michigan Department of Community Health says the state's Medicaid prescription costs have reached $1 billion a year and the new program could save at least $42 million this year. The Department of Community Health says the plan won't compromise care. The list of preferred drugs was developed by a team of 11 physicians and pharmacists recommended by the department and selected by GOP Gov. John Engler. The department also points out that health maintenance organizations issue similar preferred lists to their physicians. "We are not trying to incorporate something that is completely unheard of in the market," said Department of Community Health spokeswoman Geralyn Lasher. But Gadowski says the program could unravel years of treatment. The drugs he takes that didn't make the list include the anti-depressant Wellbutrin, which he says costs about $125 a month, and the anti-inflammatory drug Vioxx, which costs about $115 a month. Drug companies are infuriated because Michigan developed the list without their input, then told companies they would have to offer discounts beyond those the federal government already requires. The state defends its decision. "It was done quietly because we wanted to be able to put forward a sound plan without that line of lobbyists trying to shape the plan in their best interests," Lasher said. The Pharmaceutical Research and Manufacturers of America, or PhRMA, sued the state Nov. 30. The trade group, which represents more than 40 companies, says Michigan overstepped its authority. PhRMA represents those who refused to cooperate with Michigan's plan, including Pfizer Inc., Merck & Co., Eli Lilly and Co., Pharmacia Corp., Johnson & Johnson and Wyeth-Ayerst Pharmaceuticals. Companies with a number of drugs on the preferred list include Schering-Plough Corp., the maker of the allergy drug Claritin, and Bristol-Myers Squibb Co. Spokespeople for Schering-Plough and Bristol-Myers wouldn't comment. Dr. David Johnson, the state's chief medical executive and head of the 11-member committee, said the list was written in several phases. First, the committee listed what it considered the best drugs in 40 categories, substituting generics whenever possible. If manufacturers refused to discount the drugs on that list, committee members could make a case for the drugs to stay. In many cases, Johnson said, those drugs remained. Doctors who want to prescribe drugs not on the list will have to call a technician trained to ask a series of questions. Johnson said that process will not be as time-consuming as opponents make it out to be. He also said exceptions may be made for patients like Gadowski. "We're not going to make this an onerous process," he said. But some patients find it hard to trust the state. Medicaid recipient David Halboth, who suffers from severe depression, says it took him a decade of trial and error before he went on the anti-depressant Zoloft. The drug is not on the state's preferred list. "You've got a group of people who struggle on a daily basis to maintain a decent quality of life, and the state is making it much, much harder," said Halboth, 41, of Holly. "It will, in the long run, cost more to not properly care for people with mental illnesses." ___
Jan. 22 The Supreme Court set a constitutional limit today
on the growing state practice of keeping convicted sexual predators
in extended civil confinement after their criminal sentences expire.Ruling
in a case from Kansas, one of 16 states where sex offenders face
civil commitment after release from prison, the court said states
must prove not only that an offender remained dangerous and was
likely to repeat the crime but also that a "serious difficulty
in controlling behavior" was part of the psychiatric diagnosis.Writing
for the 7-to-2 majority, Justice Stephen G. Breyer said the Constitution's
guarantee of due process required this additional finding to make
certain that an offender subjected to civil confinement was not
simply a "typical recidivist convicted in an ordinary criminal
case." Justices Antonin Scalia and Clarence Thomas dissented.Some
1,200 convicted sex offenders are confined under civil commitment
laws.With this decision, the court did not so much make new law
as it refined and explained its ruling in a 1997 case that also
concerned the Kansas Sexually Violent Predator Act. In that case,
Kansas v. Hendricks, the court's first to consider a law of this
type, the justices rejected a broad constitutional attack on the
statute in part by concluding that the law was limited to sex offenders
who were "unable to control their dangerousness." In that
decision, the court did not define the category more precisely,
in part because the lifelong child molester whose case was at issue,
Leroy Hendricks, had testified that he would never be able to control
himself. The meaning of "unable to control" was consequently
not in doubt, at least as it applied to Mr. Hendricks.But the defendant
in the case today, Michael T. Crane, who exposed himself to women
who worked in retail establishments and pleaded guilty to sexual
battery, argued that the Hendricks decision required the state to
show that he had a total lack of control over his sexual behavior.
The Kansas Supreme Court, agreeing with that interpretation of the
Hendricks decision, overturned Mr. Crane's civil commitment order
on the grounds that the state had not proved a complete lack of
control.The decision today in Kansas v. Crane, No. 00-957, vacated
the state court's ruling, elaborated on the cryptic definition of
the Hendricks ruling and ordered Kansas to apply the new definition
in a new hearing.The court expressed no view on how the decision
would apply to Mr. Crane. In fact, the opinion invited case-by-case
application and development in this area of the law, all but ensuring
Supreme Court appeals."We have sought to provide constitutional
guidance in this area by proceeding deliberately and contextually,"
Justice Breyer said, adding: "The Constitution's safeguards
of human liberty in the area of mental illness and the law are not
always best enforced through precise bright- line rules."In
his dissent, Justice Scalia accused the majority of "gutting"
the court's decision in the earlier case and of failing to give
states adequate guidance for the future. He said that while Justice
Breyer's opinion "certainly displays an elegant subtlety of
mind," it left the states with "not a clue as to how they
are supposed to charge the jury!" The majority agreed with
Kansas that a complete lack of control should not be a prerequisite
for civil commitment. Noting that "most severely ill people
even those commonly termed `psychopaths' retain some
ability to control their behavior," Justice Breyer said that
"an absolutist approach is unworkable."Meanwhile, the
court rejected the state's position that the control issue did not
even have to be the basis for a separate inquiry.Kansas had argued
that proof of dangerousness, coupled with a mental abnormality,
was sufficient. But Justice Breyer said that without tying civil
commitment to a psychiatric-based lack of control, civil commitment
would not be sufficiently different from criminal punishment.The
premise of the civil commitment statutes is that sex offenders will
not only be confined, but treated, although the extent to which
effective treatment takes place in these programs is disputed. Given
the court's emphasis on a case-by-case application, the ruling's
impact on those currently confined is unclear and will take some
time to play out.Stephen R. McAllister, dean of the University of
Kansas Law School, who worked on the case for Attorney General Carla
J. Stovall of Kansas, said he agreed with Justice Scalia that "once
you get away from all or nothing, it's hard to figure out what to
do." Nonetheless, Mr. McAllister said in an interview, the
court had suggested a standard that Kansas and the other states
were likely to find "pretty manageable."States will not
need to amend their laws, he said, but rather to make sure that
juries are separately instructed on the question of a defendant's
lack of control.Jody Manier Kris, a lawyer here who filed a brief
for the National Association of Criminal Defense Lawyers, said the
decision "poses a pretty significant evidentiary standard that
can be judicially enforced." Ms. Kris called the decision positive
but predicted that states would be back with more cases.Stephen
J. Morse, a professor of law and psychiatry at the University of
Pennsylvania Law School who has written widely in this area, predicted
that the decision, which he called "too amorphous," would
prove to be "carte blanche for the states." Mr. Morse
said that psychiatrists testifying as expert witnesses for the state
"will learn to tailor their testimony" to show that the
defendant "really can't control his behavior."